J Ayub Med Coll Abbottabad 2010;22(4)
ORIGINAL ARTICLE
AUDIT OF SHARP WEAPON DEATHS IN METROPOLIS OF KARACHI
–AN AUTOPSY BASED STUDY
Farhat Hussain Mirza, Qudsia Hasan*, Akhtar Amin Memon, Syeda Ezz-e-Rukhshan Adil
Department of Forensic Medicine, Dow Medical College, DUHS, *Ziauddin Medical University, Karachi, Pakistan
Background: Sharp weapons are one of the most violent and abhorrent means of deaths. This study
assesses the frequency of sharp weapon deaths in Karachi. Methods: This was a cross sectional study,
and involves the deaths by sharp weapons autopsied in Karachi during Mar 2008–Feb 2009. Results:
This study reports that the frequency of sharp weapon deaths in Karachi is similar to some other studies
conducted in different regions of Pakistan, yet it is very high as the population of Karachi is way more
than any other metropolis of Pakistan. Our study reported that out of 2090 medico-legal deaths in
Karachi during the study period, 91 deaths were due to sharp weapons, including 73 (80.2%) males and
18 (19.8%) females. 100% of the deaths were homicides, so none were suicides. Deaths were more
frequent in age group ranging from 20–39 years (59.3 %). Conclusion: Sharp weapon deaths continue
to be a means of quite a number of deaths in Karachi. Such violence depicts intolerant and frustrated
nature of the citizens.
Keywords: Autopsy, homicide, sharp weapon, death
INTRODUCTION
Sharp force trauma commanded the position of weapon
of choice for killing man and wild animals throughout
the world since the time immemorial. It has always been
a crucial and condemnable method of fatalities, either
suicidal or homicidal. It is regarded as an extremely
violent manner of killing. If homicidal, it indicates
extreme hatred for the dead from the murderer and at
many times, the mental instability of the murderers.1
Sharp Weapons still stand as a very frequent cause of
medico-legal deaths. The usual weapons for cutting and
stabbing in today’s era in this area especially are knives,
daggers, ice picks, hatchets and choppers. It has been
observed that these weapons are used in enmity,
robberies, street crimes, snatching especially in public
transport and some times by the addicts. Such vicious
means of deaths are indicative of extreme violence;
increasing frequency of which leads our attention
towards the developing sense of frustration and lack of
tolerance, indicative of mental disturbances in
individuals.2
Death by Sharp Weapons is an underrated
issue which needs proper attention. In Pakistan, very
limited work has been done on sharp weapon injuries,
and has reported a declined trend. A three-year study
from Hyderabad reported 10% of the unnatural deaths to
be due to sharp weapons.3 A study from Abbottabad
reported sharp weapons to be the means for 5% of
homicidal deaths.4 Our study aimed to audit the deaths
by sharp weapons in Karachi, directing the attention of
the concerned authorities towards this dreadful issue in
this major and most populated metropolis of Pakistan.
Death by Sharp Weapons is an underrated
issue which needs proper attention. Some studies within
Pakistan have reported sharp weapons to be the second
most important means of homicidal deaths.5,6
176
MATERIAL AND METHODS
This was a descriptive cross-sectional study, extending
over a period of 1 year from March 1, 2008 to February
28, 2009 that included all reported sharp weapon deaths
autopsied at Civil Hospital, Jinnah Postgraduate Medical
Centre, and Abbasi Shaheed Hospital, Karachi.
The cases included in this study were those
where the death could only be attributed to direct effect
of use or infliction of sharp edged/pointed weapons.
The medico-legal deaths in Karachi by means
other than sharp weapons, or the deaths which were not
autopsied or the dead bodies were handed over to
relatives directly were excluded.
A detailed autopsy was performed in each case
of 2,090 medico-legal deaths during the study period, to
determine the cause and manner. Details were collected
for those identified to be due to sharp weapons.
Statistical data was analysed using SPSS-15.
The frequency and percentages were calculated for all
categorical variables including gender, manner and body
parts affected of sharp weapon deaths. The Mean±SD
was calculated for age.
RESULTS
The total number of medico-legal deaths reported during
the study period was 2,090 out of which 91 were due to
sharp weapons giving an incidence rate of 4.35%. All
(100%) of the 91 deaths were found to be homicidal,
forming 8.06% of the 1,129 homicidal deaths during the
study period.
Out of these 91 deaths, 73 (80.2%) were males
and 18 (19.8%) females. The age range in which the
most (54, 59.3%) of deaths occurred was of 20–39 years
(Table-1).
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Farhat.pdf
J Ayub Med Coll Abbottabad 2010;22(4)
Table-1: Frequency of age group involved in
sharp weapons deaths
Age group
19 years and less
20–39 years
40–59 years
≥60 years
Total
Frequency
9
54
19
9
91
Percentage
9.9
59.3
20.9
9.9
100
Most (67, 60.9%) of the deaths were due to
stab wounds while 19 (20.87%) were cut throats and 5
(5.49%) were decapitated. It was also noted that out of
these 67 stab wounds deaths, abdomen was involved in
majority of the cases (n=48, 71.64%). Chest was
involved in 08 cases (11.94%) while 11 cases involved
both chest and abdomen (16.41%). Table-2 shows the
frequency of body parts involved in deaths by sharp
weapons with damage to intestines being the most
common (44%) followed by neck (26.4%).
Table-2: Frequency of body parts involved in
deaths by Sharp Weapons
Body Parts Involved
Neck
Intestines
Lungs
Heart
Liver
Kidneys
Spleen
Total
Frequency
24
40
9
7
8
2
1
91
Percentage
26.4
44.0
9.9
7.6
8.8
2.2
1.1
100
DISCUSSION
Our study reports 91 sharp weapon deaths among all the
2090 medico-legal deaths; giving 4.35% incidence of
sharp weapons deaths in Karachi from Mar 2008 to Feb
2009. Studies conducted in other regions of Pakistan
show a similar trend. A study conducted at Peshawar
show that during the period of 3 years from Nov 1999 to
Oct 2002, 63 (3.058%) deaths out of 2,060 cases
brought for autopsy occurred due to sharp weapon
injuries7, while a study from Lahore during Jan to Jun
2000 reported 23 (10.8%) sharp weapon deaths out of
213 medico-legal cases giving a slightly high incidence
of the casualties due to sharp weapons8.
A very significant finding of our study was that
100% of the 91 sharp weapon deaths were homicides,
thus constituting 8.06% of the total 1,120 homicidal
deaths reported during our study period, which is slightly
higher than a study from Abbottabad that reported 5%
sharp weapon deaths out of the 40 cases of homicides.4
A few other studies of Pakistan, have reported a
relatively higher rate of sharp weapon deaths. In a study
from Larkana from Jan to Dec 1998, 17% cases were
due to sharp weapons.9 One year study at Faisalabad
reported 25.5% out of 188 homicidal deaths were due to
sharp weapons.6
The global statistics show that sharp edged and
pointed weapons are still being used for causing wounds
as well as deaths, though the ratio as compared to
firearms displays decline in majority of countries, barring
England and India, where deaths following cutting and
stabbing phenomenon shows a rising frequency. The
official statistics for England and Wales indicate that the
use of sharp object is the most common mechanism of
homicide (29%), while firearms accounting for only 9%,
while among the first world countries, rates of homicide
by cutting or piercing range between 0.2 (France) and 1.1
(USA) per 100,000.10 Assault using a knife is common in
the UK. Between Feb 1992 and Dec 1996, 120
individuals died or received hospital treatment in
Edinburgh only after being assaulted with a knife, 20
(17%) of them died as a result of injuries.11 A study of
homicides involving knives and other sharp objects in
Scotland, 1981–2003 show that there is rapid increase in
homicide involving knives and over 20 years, the
homicide rate rose by 83%, whilst that involving knifes
increased by 164%.12 A review of sharp injury fatalities
in New York city in 1999 showed that there were 120
deaths, 101 homicides, 17 suicides and 2 accidents. The
cause of death in 112 was due to stab(s) and 8 were
incised wounds. Additionally, the detection of ethanol
and/or illicit drugs was 61% in homicide and 12% in the
suicidal group.13 Trends in the incidence and severity of
stab wounds in Sweden, from 1987–1994 disclosed that
the total number of deaths was 45 out of 1,315 cases of
stab wounds recorded during that period, i.e., 3.4%
fatality ratio.14 A study of stab wounds was made on
patients who attended the Accident and Emergency
Department of Glasgow Royal Infirmary during 1978–
1983. There were 318 patients, the majority (304) were
males. The most common sites of wounds were chest
(143 patients) and the abdomen (113 Patients).15 In Oslo
and Copenhagen, 141 homicides by sharp force were
committed in the ten year period from 1985–1994, which
accounted for 33% of homicides in this period.16
One year study between Aug 2004 and Jul
2005 at Casualty Department of Mulago Hospital,
Kampala, Uganda showed 3,778 patients were entered in
the study and the mortality due to stabs/cuts was 5.4%.17
In a study in Turkey 3,183 autopsies conducted in
Istanbul between 1988 and 1989 showed that 195 deaths
(6.1%) were due to stab wounds.18 In another study
conducted in Adana, Turkey, there were 2,951 medicolegal autopsies conducted during 5 years (1997–2001)
out of which 620 (21%) autopsies were of homicidal
deaths, 515 (83.06%) were males and 105 (16.94%)
females, 182 (29.35%) were cases of stabbing, which
make 6.16% of all autopsies conducted during the study
period.19 Homicidal deaths in medico-legal autopsies at
Kuala Lumpur, Malaysia were 217 out of total number
of autopsies performed over a 5 year period from 1999–
2003. Injuries caused by sharp weapons were most
common (41%) cause of death.20 In New Delhi, during
period of 1992–1996, out of 3,886 medico-legal
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J Ayub Med Coll Abbottabad 2010;22(4)
autopsies, only 232 (5.9%) were homicidal deaths and
sharp weapon injuries were most common, i.e., 34.9%.21
Karachi lies in middle in the ratio of sharp
weapons casualties, but it is still a major concern
considering that Karachi is the most populated city of
Pakistan and number of medico-legal deaths here is
huge; fire-arms being the most important means, which
covers up the still prevailing means of sharp weapons
which itself is a menace but is hidden under the massive
effects of firearms.5,6
Among the victims, males were 4 times more
frequent than females. Similar male-dominance has also
been reported by other studies in Pakistan. Kaheri et al7
reported male deaths by sharp weapons to be 5 times
more dominant than females in Peshawar, while Qadir et
al9 reported a similar 4:1 male to female ratio in deaths
by sharp weapon in Larkana. Males in our society, due to
their more outgoing nature, socialising with community,
and aggressive nature are more prone to involve
themselves in a conflict that can be the cause of enmity
leading to their deaths by homicide. A significant finding
of our study is that the majority (59.3%) of the cases
belonged to age group 20–39. This is again because
young individuals due to their more aggressive approach
can easily develop enemies who can avenge themselves
in the form of homicides.
A noteworthy finding is that none of the sharp
weapon deaths in our study were due to suicides. Studies
within Pakistan have reported sharp weapons to account
in some measures of suicides. A study conducted in
Faisalabad reported suicides by sharp weapons to
comprise 4.2% of the reported suicides. Suicides by stab
wounds are rare, while hanging, firearm and poisoning
stand as more common ways now.
We found that most of the deaths were due to
stab wounds in abdomen out of which 40 cases involved
rupturing of intestine leading to haemorrhage. The sites
of the wounds and the multiplicity of the injuries easily
distinguish a homicidal from suicidal stab wound. The
severity of stab wounds is based exclusively on the
location and depth of penetration. Important
considerations include type of weapon used, i.e., knife,
dagger, sword or even ice pick, length, shape, straight or
curved and manner of assault (overhand versus
underhand).
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CONCLUSION
22.
Sharp weapon deaths continue to be a means of quite a
number of deaths in Karachi. Such violence depicts
intolerant and frustrated nature of the citizens.
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Address for Correspondence:
Dr. Farhat Hussain Mirza, Department of Forensic Medicine, Dow Medical College, DUHS, Karachi, Pakistan.
Cell: +92-300-9230198
Email: [email protected]
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